More children are victims of abuse than of SIDS, study finds

As the state's major newspapers and the Cabinet for Health and Family Services battle over how public records pertaining to child abuse and neglect should be handled, children continue to be victims across the country. A study published Monday in the journal Pediatrics has found child abuse affects more babies in the U.S. than SIDS. (Photo by Getty Images)

The rate of hospital admissions for SIDS, or sudden infant death syndrome, is 50 per 100,000 for children under the age of 1. In the same age bracket, 58.2 per 100,000 babies are getting hurt as a result of abuse, reports Bonnie Rochman for Time's Healthland.

"These kids are physically vulnerable because they're small," said Dr. John M. Levanthal, leader author of the study and professor of pediatrics at Yale Medical School. "They are challenging for some parents to take care of because they cry, it's hard to understand what they want and parents can get frustrated, exhausted and angry."

Indeed, abuse most often stems from parents. Previous research shows men, including fathers, stepfathers and boyfriends, are the "largest single group of perpetrators," Rochman reports.

Research conducted at Yale found that in 2006 4,569 children under the age of 18 were brought to the hospital as a result of abuse, 300 of whom died. The resulting death rate of 6 percent was "substantially higher than for children who were admitted for other kinds of injuries or medical or surgical problems," Rochman reports.

The most common injuries included abusive head trauma, fractures, burns, abdominal injuries and bruises. Those hospitalizations cost about $73.8 million and lasted twice as long as children who suffered other kinds of injuries.

Children living in poverty were the victims of abuse much more often, getting hit at six times the rate of children not on Medicaid.

A report showed 18 Kentucky children died from child abuse or neglect last year, down from 33 in 2009, but those numbers have since come into question. A survey in Kentucky and three other states showed child abuse rates have risen significantly since the economy went into recession — from 8.9 per 100,000 children from 2004 to December 2007 to 14.7 per 100,000 during 2008 and 2009. (Read more)

As with health care reform, dentistry should move from volume to value, report urges

Dentists should be paid according to the outcomes of their patients and should be monitored more closely given that there is great variability and expense when it comes to dental care, a new report argues.

"I think there is broad consensus that the current oral health system doesn't meet the needs of a significant portion of the population," said Paul Glassman, professor of dental practice at University of the Pacific Arthur A. Dugoni School of Dentistry and lead author of the report "Oral Health Quality Improvement in the Era of Accountability."

The report, funded by the W.K. Kellogg Foundation and the DentaQuest Institute, was released as the U.S. healthcare system is undergoing a transition from the "pay-for-performance" model to "value-based care." The paper argues oral health should likewise move in the same direction and make the transition from "volume to value."

The report found dentistry is the second-highest out-of-pocket health care cost after prescription medicines, and, like health care in general, its cost is increasing, reports Laird Harrison for Medscape News. Another issue is the government just pays for about 6 percent of dental care nationally, the report found, leaving people to pay for care themselves.

While expensive, the care dentists give can be inconsistent, the report found. Though Glassman said dentistry is not lacking in standards, there is limited evidence of the best practice for most dental procedures, the report found.

Another issue, the report contends, is dentists are paid according to what they produce, not by how successful they are in their outcomes. As such, dentists are resistant to change since there are few incentives to implement quality improvement programs. "If the question is 'what's the optimum system for providers,' then many feel the optimum system is what we have now," Glassman said. "If the question is 'what's the optimum system for the public,' then you will come to a different set of assumptions."

To help improve the system, the report recommends a number of proposals, including:

• The increased use of electronic health records

• Development and use of measures for oral health outcomes

• Tying incentives to the oral health of the population being served

• Relying more on allied dental professionals and non-dental professionals

It also suggests relying more heavily on telemedicine, with Glassman envisioning "hygienists and dental assistants going into schools, nursing homes, and other areas with underserved populations to deliver preventive care," Harrison reports. "Dentists, monitoring from afar with access to dental charts stored on the Internet, could gain more patients."

Steven Silverstein, director of the graduate program in dental public health at the University of California San Francisco, said the report was "outstanding" and agreed that the care dentists give can be inconsistent, saying, "If you ask 10 dentists to look at a patient you will get 10 different opinions." Part of the problem, he said, is 98 percent of dentists either practice alone or with one or two partners.

Silverstein did take issue with the fact that the report did not mention the high cost of dental education; didn't take cosmetic dentistry into account; and it did not explain how reform could lower the cost of dental care. (Read more)

Judge rails against state's handling of child-abuse records, Beshear's defense of cabinet

The judge who handled the case of 9-year-old Amy Dye, who was beaten to death last year by her adoptive brother, sent an op-ed piece to several newspapers criticizing Gov. Steve Beshear's move to back the Cabinet for Health and Family Services in its battle to prevent full disclosure of child-abuse death records.

"The publicity surrounding recent tragic deaths of children in Kentucky, and the now public shenanigans of the cabinet — caught lying about what it knew and when it knew it — have triggered a rare public anger," writes Circuit Judge Tyler Gill, left. "Openness should always be the rule where government is involved."

The Lexington Herald-Leader and The Courier-Journal sued the cabinet last year to obtain records about children who died from abuse or neglect. Though Franklin Circuit Judge Phillip Shepherd ruled in three cases that files should be released, the cabinet long refused to do so. "Shepherd said that in cases of children killed or badly hurt, the public has a legitimate, overriding interest in access to information that could show how the cabinet performed its job of protecting children," reports Bill Estep for the Herald-Leader.

In an order issued Jan. 19, Shepherd ruled the cabinet could omit very limited information, including the names of children who are hurt but don't die and the names of people, such as teachers, who report suspected abuse. The cabinet has appealed, saying it should be allowed to redact more information than that. Since Shepherd's ruling, the cabinet has released the internal reviews of 85 cases in which children were hurt or died in 2009 and 2010, along with extensive case files — though it has redacted information it sees fit on all of the documents.

Gill rails against the cabinet's appeal. "Do not be misled," he writes. "The cabinet's appeal of the Franklin Circuit Court ruling is not a high-minded effort to protect the privacy of persons who report child abuse. It is to protect the cabinet."

Kerri Richardson, spokeswoman for Beshear, said Gill is wrong about the cabinet's motivations. If it meant to protect itself, it would not have released hundreds of pages of records. "The cabinet is not just protecting those who report child abuse," she told Estep. "The cabinet is trying to protect innocent victims of abuse or neglect and the innocent families of victims of abuse or neglect."

But, given his handling of Amy Dye's case, Gill sees it differently. "The people of Todd County are painfully aware of the likelihood that a multitude of reports of suspected abuse were made by teachers and school officials about Amy Dye in the years before her death, several of which may have been mishandled or misplaced. I seriously doubt any of those who made reports would have allowed fear for their personal safety to keep them from speaking out. Their fear was for Amy," he writes. (Read more)

Funding substance-abuse treatment for Medicaid recipients could help 6,000 people, official says

If the budget proposed by Gov. Steve Beshear is passed, 6,000 Kentuckians on Medicaid could be treated for substance abuse, ultimately saving the tax system hundreds of thousands of dollars.

That was the message Monday during a House budget subcommittee on health and human services hearing. "All of the research shows that this is a smart thing to do," said Stephen Hall, commissioner of the Department for Behavioral Health, Developmental and Intellectual Disabilities.

Treating a person with intensive drug addiction services costs $2,500. But an adult who is not treated costs taxpayers more than $23,000 in prison and other costs, Hall said.

Kentucky is "one of only seven states that does not offer substance-abuse treatment in its Medicaid program," reports Beth Musgrave for the Lexington Herald-Leader.

Beshear has proposed an expansion of drug addiction services in his two-year budget, one of few new spending projects. He is requested $11.6 million in the first year of the budget, which would help about 4,500 people. He wants another $14.9 million in the second year of the budget to help about 1,300 people. Kentuckians who are eligible for Medicaid and who have a mental illness and substance-abuse problems will have priority in the program, as will those with substance-abuse issues and custody of a minor child.

Though "many on the House budget committee applauded the move," Musgrave reports, at a time when state agencies are facing 8.4 percent cuts, the spending project is a hard sell. "It's difficult to start any new programs," said Sen. Robert Leeper, an Independent of Paducah and chairman of the Senate Appropriations and Revenue Committee. (Read more)

Health departments face more cuts as demand for services grows

More cuts to Kentucky's public-health system have been proposed at a time when the demand for services is growing, officials say. In his state budget proposal, Gov. Steve Beshear suggested public health cuts of 8.4 percent in each of the next two budget years, the same cut he recommended for most other state agencies.

"It's going to have an impact on us being able to provide services (for poor patients)," Dr. Steve Davis, the acting public health commissioner, told the House human services budget subcommittee.

The cuts will mean "the 58 health departments that serve Kentucky's 120 counties will have fewer resources to provide services such as immunizations, cancer screening, diabetes care and maternal and child care," reports Deborah Yetter for The Courier-Journal. Public health will also likely be cut at the federal level. This budget year, public health received $239 million in federal funds. It received $59 million for its General Fund from the state, which would drop to about $56 million if the cuts pass.

Davis said there are no plans yet for how to absorb the cuts. "Every single program we have is going to be on the table," he said. (Read more)